posted by
mrpg
on Monday August 14 2017, @03:00AM
from the crisis dept.

"exec" writes:

Since 2009, hospital intensive care units have witnessed a stark increase in opioid-related admissions and deaths, according to new study led by researchers at Beth Israel Deaconess Medical Center’s (BIDMC) Center for Healthcare Delivery Science. Published online today ahead of print in the Annals of the American Thoracic Society, the study is believed to be the first to quantify the impact of opioid abuse on critical care resources in the United States. The findings reveal that opioid-related demand for acute care services has outstripped the available supply.

Analyzing data from the period between January 1, 2009 and September 31, 2015, the researchers documented a 34 percent increase in overdose-related ICU admissions. The average cost of care per ICU overdose admissions rose by 58 percent, from $58,517 in 2009 to $92,408 in 2015 (in 2015 dollars). Meanwhile opioid deaths in the ICU nearly doubled during that same period. "This study tells us that the opioid epidemic has made people sicker and killed more people, in spite of all the care we can provide in the ICU, including mechanical ventilation, acute dialysis, life support and round-the-clock care," said the study's lead author, Jennifer P. Stevens, MD, associate director of the medical intensive care unit at BIDMC and assistant professor of medicine at Harvard Medical School.

[...] These data not only document the scope of the opioid abuse epidemic, they also reveal its complexity. Stevens and colleagues suggest that any opioid overdose-related admission is a preventable one, and that the team's findings not only represent the need for increased acute care resources, but also for expanded opioid-abuse prevention and treatment.

Related Stories

Pain-pill giant Purdue Pharma LP will stop promoting its opioid drugs to doctors, a retreat after years of criticism that the company's aggressive sales efforts helped lay the foundation of the U.S. addiction crisis.

The company told employees this week that it would cut its sales force by more than half, to 200 workers. It plans to send a letter Monday to doctors saying that its salespeople will no longer come to their clinics to talk about the company's pain products.

"We have restructured and significantly reduced our commercial operation and will no longer be promoting opioids to prescribers," the company said in a statement. Instead, any questions doctors have will be directed to the Stamford, Connecticut-based company's medical affairs department.

OxyContin, approved in 1995, is the closely held company's biggest-selling drug, though sales of the pain pill have declined in recent years amid competition from generics. It generated $1.8 billion in 2017, down from $2.8 billion five years earlier, according to data compiled by Symphony Health Solutions. It also sells the painkiller Hysingla.

Congress has responded strongly to a joint investigation by CBS and The Washington Post (archive) about Drug Enforcement Administration (DEA) employees becoming lobbyists for the pharmaceutical industry, and the passage of a bill in 2016 hobbling the DEA's ability to go after opioid distributors and suspicious drug sales:

Drug overdose deaths in the United States have more than doubled over the past decade. The CDC says 188,000 people have died from opioid overdoses from 1999 to 2015.

Joe Rannazzisi used to run the DEA's diversion control. He told "60 Minutes" correspondent Bill Whitaker that the opioid crisis was aided in part by Congress, lobbyists and the drug distribution industry. The DEA says it has taken actions against far fewer opioid distributors under a new law. A Justice Department memo shows 65 doctors, pharmacies and drug companies received suspension orders in 2011. Only six of them have gotten them this year.

[...] [The] DEA's efforts may have been undermined by the so-called "revolving door" culture in Washington. At least 46 investigators, attorneys and supervisors from the DEA, including 32 directly from the division that regulates the drug industry, have been hired by the pharmaceutical industry since the scrutiny on distributors began.

From The Washington Post:

The chief advocate of the law that hobbled the DEA was Rep. Tom Marino, a Pennsylvania Republican who is now President Trump's nominee to become the nation's next drug czar. Marino spent years trying to move the law through Congress. It passed after Sen. Orrin G. Hatch (R-Utah) negotiated a final version with the DEA.

The Food and Drug Administration approved a powerful new opioid Friday, despite strong criticism and accusations that it bypassed its own advisory process to do it.

The new drug, Dsuvia, is a tablet that goes under the tongue. It is designed for use in the battlefield and in other emergency situations to treat intense, acute pain.

Known generically as sufentanil, it's a new formulation of a drug currently given intravenously. Critics say it will be incredibly easy for health workers to pocket and divert the drug to the illicit drug market and because it is so small and concentrated, it will likely kill people who overdose on it.

"This is a dangerous, reckless move," said Dr. Sidney Wolfe senior adviser of Public Citizen's Health Research Group. He questions whether there's need for yet another synthetic opioid when the U.S. is in the throes of an opioid overdose crisis.

Sufentanil is described as 5 to 10 times more potent than fentanyl and 500 times as potent as morphine. Carfentanil is 100 times more potent than fentanyl, but is only approved for the veterinary use of tranquilizing large animals. Sufentanil is the strongest opioid painkiller available for use in humans.

Synthetic opioids such as fentanyl have overtaken prescription opioids as the No. 1 killer in the opioid epidemic, according to a new report.

The report, published Tuesday in the journal JAMA [DOI: 10.1001/jama.2018.2844] [DX], calculated the number and percentage of synthetic opioid-related overdose deaths in the United States between 2010 and 2016 using death certificates from the National Vital Statistics System. The researchers found that about 46% of the 42,249 opioid-related overdose deaths in 2016 involved synthetic opioids such as fentanyl, while 40% involved prescription drugs.

That's more than a three-fold increase in the presence of synthetic opioids from 2010, when synthetic drugs were involved in approximately 14% of opioid-overdose deaths.

It's come to be so bad that we actually have hard-hit states suing [nytimes.com] opioid manufacturers.

And just in time for the government to finally crack down on doctors writing rampant unmedical opioid prescriptions, now the streets are flooded with that Afghan heroin to take their place, cultivated from those same poppy fields we had our own soldiers guarding.

The CIA has their tendrils in everything. Don't believe me? As yourselves why all big media and even local media are all saying the exact goddamn things about the exact goddamn events, notably last election.

This is different. Heroin and crack are like Hurricane Katrina but opioids are like Hurricane Sandy. The opioid crisis is an emergency. I'm saying officially right now it is an emergency. Because it's striking down my beautiful, beautiful white Americans. Who marched -- and drove -- so bravely this weekend in Charlottesville. To make America great again. 🇺🇸

why all big media and even local media are all saying the exact goddamn things

Because the media is a monoculture echo-chamber: Seeing how cable subscribers are sheep willing to pay for advertising as original content, advertising became the single most important source of income. And if everyone is catering to the same customers, the party line becomes the only line.

You don't need the CIA as a single antagonist of a conspiracy when you have your entire society worshiping Mammon. When copyright laws promote the usage of new and highly addictive narcotics over perfectly suitable drugs you get whole nations rallying behind your cause: A military industrial complex pushes towards bombing the competing drug-lords in Mexico and Afghanistan. Script writers promoting gang-busting cops as the heroes of the people. Regulators illegalizing anything old enough to be made into a generic while doctors are being lied to about how the old drugs were very harmful and the new ones are perfectly safe...

It's a well-oiled, fine-tuned machine of culminating interests that doesn't need conspiracies for the cogs to turn.

In the 1980s the CIA was largely responsible for the rise of crack cocaine in the USA because it funded the Contras in Nicaragua. They were flying tons of cocaine to street dealers like Freeway Rick Ross through Nicaraguan émigrés such as Danilo Blandón who fled the country after the Sandinistas took power. Ultimately, the Contras succeeded in overthrowing the Sandinistas thanks in no small part to the drug money that the CIA allowed them to receive. This time, now that the CIA has seems like it has quite a bit of control over the poppy fields of Afghanistan, are they perhaps doing the essentially same thing today, but this time through ostensibly legal channels?

Trump seemed to be saying it was heroin being brought in from Mexico that was to blame. Actually is mostly from prescription drugs like Morphine, Oxycodone, Fentanyl and Naloxone. The drug dealers are not hanging out on street corners, They are the big pharmaceutical companies who push out pain killers to doctors and clinics all over the U.S.From the way Trump seems to be behaving I wouldn't be surprised if he wasn't a big customer himself.

Stuff like this isn't going to stop until people stop giving the healthcare industry their money. Since there is a new law (in the US) forcing people to give the healthcare industry money, I don't expect it to stop anytime soon. These hospitals, doctors, researchers, insurance companies, etc are *not* your friends and you should be very scared any time you interact with them.

There is nothing wrong with prescribing it. My doctor gives me prescription opioids. I use them occasionally. Sometimes for days in a row. When I don't need them I stop. When I need a refill, I ask, and have never been refused. Sometimes when the doctor asks if I need a refill, I already have plenty, thanks. I've taken them for years, nearly a decade. My use has not increased over time.

The thing is, I have a great life. I don't want to screw it up with pills. I use them as a tool -- when I NEED them, and only then. Something that improves my quality of life, just like other medications do. When I do use them I am always looking for what is the smallest possible dose I can use that will be enough.

I am simply unable to understand how people get addicted to these things. Or why. What is the appeal? The attraction? Why trade a great life for a feeling from pills? I don't get it.

I also cringe at the idea that people want to take away this useful medicine from people who benefit greatly from it.

--ALL LIABILITY IS EXPRESSLY DISCLAIMED FOR PERSONAL INJURY OR DEATH THAT RESULTS FROM READING THE SOURCE CODE.

I also cringe at the idea that people want to take away this useful medicine from people who benefit greatly from it.

You are correct. I used to take Actifed for my seasonal allergies as that worked the best for me. It was dirt cheap so I could pick up a package of 20 for a few bucks. Then the meth-heads came and screwed it up for everybody. Now I cannot find it anywhere and when I substitute Allegra or Xyrtec it costs about five to ten times as much and doesn't work as well.

I took opiate pain relievers when I dislocated my knee. I never saw what the alleged "thrill" of opiates were either. I took a couple and said screw it, Advil worked just as well. I probably still have the bottle somewhere. The only thing I have ever taken that made me loopy was a single Valium that I received at the ER and I had absolutely no interest in ever having it again.

I have rarely taken enough to be loopy. I don't see the appeal of it. I can't stand the idea of losing control of my mind, emotions and faculties. That's probably why I don't drink alcohol.

I daily take prescription nsaids stronger than advil. And tylenol. Occasionally opiates.

A couple months ago I was on vacation in Colorado. Tried some edibles while I was there to see if it would help. I thought it provided a bit of relief -- but not much. But the biggest thing was that it is not cost effective at all. At about $10 a dose, that's ridiculous. I'll stick with opiates when those times come when other drugs aren't enough. I can get a whole bottle of opiates for less than $10 -- the cost of a single dose of edibles. And unlike the cannabis, the prescription opiate is like a sledged hammer for pain. Maybe the edibles help others, but I wasn't impressed by either the effectiveness nor the cost.

--ALL LIABILITY IS EXPRESSLY DISCLAIMED FOR PERSONAL INJURY OR DEATH THAT RESULTS FROM READING THE SOURCE CODE.

Many go in with the same intention and usage pattern as you. Many do not get a high from it and use it exclusively for pain management as you do. Everyone is different and some are more susceptible to addiction than you. Also, your pain may be periodic, but others experience it constantly. Pain can drive you to do things you wouldn't possibly think you would be capable of.

Or maybe we could prescribe it with sane instructions. We are all trained to take pills until the bottle is empty because of antibiotics. This strategy is 110% wrong with opioids, but there is no change in labeling. Doctors and pharmacists alike tell you - even in the midst of the crisis right now - to just take the pills. No discussion of "these are for pain, take as needed". More like "take all these pills and go away, you bother me".

--If there isn't at least one reference or primary source, it's not +1 Informative. Maybe the underused +1 Interesting?

Part of that is that most pain pills work much better if you can take them before the pain starts.So doctors prescribe pills at a rate of "take one just before the previous one wears off" and give you enough for the expected duration of the pain. For chronic pain this is a great way to get addicted.

--If the only proposed solution to a problem is a tax, then it is just an excuse to tax, not a solvable problem.

The fundamental problem is that if you take the pills in anticipation of pain, rather than in response to pain, you have no way of telling if you are still in pain. Responsible use of pain killers involves easing off every once in a while to re-evaluate whether you need as much as you are taking.

--If there isn't at least one reference or primary source, it's not +1 Informative. Maybe the underused +1 Interesting?

Opiod overdose deaths are a symptomOpiod overdose deaths are a symptom(Score: 4, Insightful) by pTamok on Monday August 14 2017, @07:43AM
(2 children)

Dependency on a reliable supply of good quality opioids under sane medical supervision is not a problem - it can be managed well, but usually isn't.

The problem is, if someone who is dependent on opioids believes their supply may be cut off, they will likely do risky things to maintain their supply - such as saving a cache of pills 'just in case' (which can be found by a kid and eaten as some novel sweet), or finding other, non-medical sources that have less good quality controls and encourage criminality.

Being dependent on opioids is no fun. You get serious constipation, and your cognitive functioning is impaired - characterised as thinking slowly and fuzzily. If using opiods for pain relief, if not carefully managed, you end up needing ever higher dosages to get the same perceived relief. You can even end up being sensitised to certain types of pain. Opioids are no miracle drug.

There is a stigma associated with the use of opioids, and a large number of people (including many medical professionals, unfortunately) regard addiction/dependency as a form of moral delinquency. Punishing opioid addiction is like telling a depressed person to man up and just be happy - it might work occasionally, but in general it is not a good strategy. If you look at the experience of people trying to give up alcohol abuse, or smoking tobacco, you see that it is difficult, people often fail, and some only succeed after several attempts. We need to recognise that giving up opioids is at least as difficult - people need support, clean supplies, and understanding that some people might not make it. People die of alcohol abuse, tobacco smokers have higher mortality, and opioid addiction/dependency will lead to poor health outcomes - but punishment and moral castigation is not the way forward. Harm reduction is the way to go, not moral panic.

Re:Opiod overdose deaths are a symptom(Score: 0) by Anonymous Coward on Monday August 14 2017, @10:18AM

We must change more, not go back to the past?(Score: 2) by meustrus on Monday August 14 2017, @05:02PM

Why is all the coverage of this "opioid epidemic" focused on how we can make changes to fix it? Something clearly changed around 2009 that created a crisis. I don't know what it is, but we need to focus on fixing the root cause instead of maintaining the current system.

--If there isn't at least one reference or primary source, it's not +1 Informative. Maybe the underused +1 Interesting?

The problem is systemic. That is, the system is too busy trying to decide who needs to be punished and how severely to make the problem go away that we have completely failed to consider that law enforcement getting involved in a medical issue is itself the cause of the problem.

We have actual evidence that opioid addiction need not become a major problem *IF* a supply is readily available *AND* other issues in the person's life are adequately addressed.

Threatening doctors who, in the opinion of someone who never went to medical school, over-prescribes just results in patients getting abruptly cut off. They're practically shoved into the waiting arms of black market dealers. But since the addiction is a side effect of medical treatment, wouldn't it make more sense to treat the problem medically? We don't arrest people who relapse from other medical conditions. We don't belittle sufferers of other diseases if they can't come off of their meds yet and we certainly don't just cut them off and tell them to tough it out.

Like many other diseases, the way to keep people out of critical care is to get them under treatment before their condition gets that bad.